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File: 3.php
<div class="panel"> <div class="panel-heading" style="background: #275555ff; color: honeydew;"> <h2 align="center" style="margin-top: 10px;">FORM ISIAN<br><b>ALAMAT CALON MAHASISWA</b> </h2> <!-- <hr> --> </div> <div class="panel-body"> <div class="form-group"> <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">Jenis tempat tinggal <span class="text-danger">*</span></label> <div class="col-sm-9" style="margin-top:3px;"> <select class="form-control bg-blue class" data-placeholder="Pilih jenis tempat tinggal" name="jenis_tinggal" data-parsley-group="block2" data-parsley-errors-container='div[id="error-jenis_tinggal"]' required> <option value="">Pilih jenis tempat tinggal</option> <option value="1">Tinggal dengan orangtua/wali</option> <option value="2">Ikut saudara/kerabat</option> <option value="3">Kontrak/kost</option> <option value="4">Lainnya</option> </select> <div id="error-jenis_tinggal" style=" background:#FFBABA;color: #D8000C; width:auto;border-radius:5px;padding-left:10px;"></div> </div> </div> <div class="form-group" style="padding-bottom:30px;"> <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">Alamat <span class="text-danger">*</span></label> <div class="col-sm-9 prepend-icon"> <input type="text" name="alamat_siswa" class="form-control bg-blue" placeholder="Alamat siswa" maxlength="100" data-parsley-group="block2" data-radio="iradio_square-blue" data-parsley-errors-container='div[id="error-alamat_siswa"]' required> <i class="fa fa-home" style="margin-left:15px;"></i> <div id="error-alamat_siswa" style=" background:#FFBABA;color: #D8000C; width:auto;border-radius:5px;padding-left:10px;"></div> <div id="pesan_komentar">*Cukup dituliskan nama dusun/jalan dan rt/rw (sesuai KK)</div> </div> </div> <div class="form-group" style="padding-bottom:30px;"> <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">Kelurahan/Desa <span class="text-danger">*</span></label> <div class="col-sm-9 prepend-icon"> <input type="text" name="desa" class="form-control bg-blue" placeholder="Desa" maxlength="100" data-parsley-group="block2" data-radio="iradio_square-blue" data-parsley-errors-container='div[id="error-desa"]' required> <i class="fa fa-map-marker" style="margin-left:15px;"></i> <div id="error-desa" style=" background:#FFBABA;color: #D8000C; width:auto;border-radius:5px;padding-left:10px;"></div> <div id="pesan_komentar">*Isi sesuai KK</div> </div> </div> <div class="form-group" style="padding-bottom:30px;"> <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">Kecamatan <span class="text-danger">*</span></label> <div class="col-sm-9 prepend-icon"> <input type="text" name="kec" class="form-control bg-blue" placeholder="Kecamatan" maxlength="100" data-parsley-group="block2" data-radio="iradio_square-blue" data-parsley-errors-container='div[id="error-kec"]' required> <i class="fa fa-map-marker" style="margin-left:15px;"></i> <div id="error-kec" style=" background:#FFBABA;color: #D8000C; width:auto;border-radius:5px;padding-left:10px;"></div> <div id="pesan_komentar">*Isi sesuai KK</div> </div> </div> <div class="form-group" style="padding-bottom:30px;"> <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">Kabupaten/Kota <span class="text-danger">*</span></label> <div class="col-sm-9 prepend-icon"> <input type="text" name="kab" class="form-control bg-blue" placeholder="Kabupaten" maxlength="100" data-parsley-group="block2" data-radio="iradio_square-blue" data-parsley-errors-container='div[id="error-kab"]' required> <i class="fa fa-map-marker" style="margin-left:15px;"></i> <div id="error-kab" style=" background:#FFBABA;color: #D8000C; width:auto;border-radius:5px;padding-left:10px;"></div> <div id="pesan_komentar">*Isi sesuai KK</div> </div> </div> <div class="form-group" style="padding-bottom:30px;"> <label class="col-sm-3 control-label" style="text-align:right; margin-top:6px">Provinsi <span class="text-danger">*</span></label> <div class="col-sm-9 prepend-icon"> <input type="text" name="prov" class="form-control bg-blue" placeholder="Provinsi" maxlength="100" data-parsley-group="block2" data-radio="iradio_square-blue" data-parsley-errors-container='div[id="error-prov"]' required> <i class="fa fa-map-marker" style="margin-left:15px;"></i> <div id="error-prov" style=" background:#FFBABA;color: #D8000C; width:auto;border-radius:5px;padding-left:10px;"></div> <div id="pesan_komentar">*Isi sesuai KK</div> </div> </div> </div> </div> <div class="col-md-12"> <div>